As long as you stay up-to-date with your vaccinations and take basic preventive measures, you’re unlikely to succumb to most of the possible health hazards. While Tanzania has an impressive selection of tropical diseases on offer, it’s more likely you’ll get a bout of diarrhoea or a cold than a more exotic malady. The main exception to this is malaria, which is a real risk throughout most of the country. Road accidents are the other main threat to your health. Never travel at night, and choose buses or private transport over dalla-dallas to minimise the risk.
Regardless of your destination, the World Health Organization (www.who.int/en) recommends that all travellers be covered for the following.
According to the Centers for Disease Control and Prevention (www.cdc.gov), the following vaccinations are (also) recommended for Tanzania:
While a yellow fever vaccination certificate is not officially required to enter Tanzania unless you’re coming from an infected area, carrying one is advised.
Check in advance if your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. Most doctors in Tanzania expect payment in cash.
Ensure that your travel insurance will cover any emergency transport required to get you at least as far as Nairobi (Kenya), or (preferably) all the way home, by air and with a medical attendant if necessary. It’s worth taking out a temporary membership with the African Medical & Research Foundation (www.amref.org) or First Air Responder (www.firstairresponder.com).
Carry a medical and first-aid kit with you, to help yourself in case of minor illness or injury. Following is a list of items to include:
International Travel and Health (www.who.int/ith) – a free, online publication of the World Health Organization
Government travel-health websites:
Wilderness and Travel Medicine by Eric A Weiss (2012)
Essential Guide to Travel Health by Jane Wilson-Howarth (2009)
Africa – Healthy Travel Guide by Isabelle Young and Tony Gherardin (2008)
Cholera is usually only a problem during natural or artificial disasters, such as war, floods or earthquakes, although outbreaks can also occur at other times. Travellers are rarely affected. It's caused by a bacteria and spread via contaminated drinking water. The main symptom is profuse watery diarrhoea, which causes debilitation if fluids are not replaced quickly. An oral cholera vaccine is available in the USA, but is not particularly effective. Most cases of cholera could be avoided by close attention to good drinking water and by avoiding potentially contaminated food. Treatment is by fluid replacement (orally or via a drip), but sometimes antibiotics are needed. Self-treatment is not advised.
Mini-epidemics of this mosquito-borne disease crop up with some regularity in Tanzania, notably in Dar es Salaam. Symptoms include high fever, severe headache and body ache (dengue used to be known as breakbone fever). Some people develop a rash and experience diarrhoea. There is no vaccine, only prevention. The dengue-carrying Aedes aegypti mosquito is active at day and night, so use DEET-mosquito repellent periodically throughout the day. See a doctor to be diagnosed and monitored (dengue testing is available in Dar es Salaam). There is no specific treatment, just rest and paracetamol – do not take aspirin as it increases the likelihood of haemorrhaging. Severe dengue is a potentially fatal complication.
Diphtheria is spread through close respiratory contact. It usually causes a temperature and a severe sore throat. Sometimes a membrane forms across the throat and a tracheotomy is needed to prevent suffocation. Vaccination is recommended for those likely to be in close contact with the local population in infected areas, but is more important for long stays than for short-term trips. The vaccine is given as an injection, alone or with tetanus, and lasts 10 years. Self-treatment: none.
Filariasis is caused by tiny worms migrating in the lymphatic system and is spread by a bite from an infected mosquito. Symptoms include localised itching and swelling of the legs and/or genitalia. Treatment is available. Self-treatment: none.
Hepatitis A is spread through contaminated food (particularly shellfish) and water. It causes jaundice and, although it is rarely fatal, it can cause prolonged lethargy and delayed recovery. If you’ve had hepatitis A, you shouldn’t drink alcohol for up to six months afterwards, but once you’ve recovered, there won’t be any long-term problems. The first symptoms include dark urine and a yellow colour to the whites of the eyes. Sometimes a fever and abdominal pain are present. Hepatitis A vaccine (Avaxim, VAQTA, Havrix) is given as an injection: a single dose will give protection for up to a year, and a booster after a year gives 10-year protection. Hepatitis A and typhoid vaccines can also be given as a single-dose vaccine, hepatyrix or viatim. Self-treatment: none.
Hepatitis B is spread through sexual intercourse, infected blood and contaminated needles. It can also be spread from an infected mother to her baby during childbirth. It affects the liver, causing jaundice and sometimes liver failure. Most people recover completely, but some people might be chronic carriers of the virus, which could lead eventually to cirrhosis or liver cancer. Those visiting high-risk areas for long periods, or those with increased social or occupational risk, should be immunised. Many countries now routinely give hepatitis B as part of childhood vaccination. It is given singly or can be given at the same time as hepatitis A.
A course will give protection for at least five years. It can be given over four weeks or six months. Self-treatment: none.
Human immunodeficiency virus (HIV), the virus that causes acquired immune deficiency syndrome (AIDS), is a major problem in Tanzania, with infection rates averaging about 5.1%, and much higher in some areas. The virus is spread through infected blood and blood products, by sexual intercourse with an infected partner and from an infected mother to her baby during childbirth and breastfeeding. It can be spread through ‘blood to blood’ contact, such as with contaminated instruments during medical, dental, acupuncture and other body-piercing procedures, and through sharing used intravenous needles. At present there is no cure; medication that might keep the disease under control is available, but these drugs are too expensive, or unavailable, for many Tanzanians. If you think you might have been infected with HIV, a blood test is necessary; a three-month gap after exposure and before testing is required to allow antibodies to appear in the blood. Self-treatment: none.
Malaria is endemic throughout most of Tanzania and is a major health scourge (except at altitudes higher than 2000m, where the risk of transmission is low, and on Zanzibar island, where it has been eradicated). Infection rates are higher during the rainy season, but the risk exists year-round and it is extremely important to take preventive measures, even if you will be in the country for just a short time.
Malaria is caused by a parasite in the bloodstream spread via the bite of the female anopheles mosquito. There are several types, falciparum malaria being the most dangerous and the predominant form in Tanzania. Unlike most other diseases regularly encountered by travellers, there is no vaccination against malaria (yet). However, several different drugs are used to prevent malaria and new ones are in the pipeline. Up-to-date advice from a travel-health clinic is essential, as some medication is more suitable for some travellers than others. The pattern of drug-resistant malaria is changing rapidly, so what was advised several years ago might no longer be the case.
The early stages of malaria include headaches, fevers, generalised aches and pains, and malaise, which could be mistaken for flu. Other symptoms can include abdominal pain, diarrhoea and a cough. Anyone who develops a fever in Tanzania or within two weeks after departure should assume malarial infection until blood tests prove negative, even if you have been taking antimalarial medication. If not treated, the next stage could develop within 24 hours, particularly if falciparum malaria is the parasite: jaundice, then reduced consciousness and coma (also known as cerebral malaria) followed by death. Treatment in hospital is essential, and the death rate might still be as high as 10% even in the best intensive-care facilities.
Many travellers are under the impression that malaria is a mild illness, that treatment is always easy and successful and that taking antimalarial drugs causes more illness through side effects than actually getting malaria. Unfortunately, this is not true. Side effects of the medication depend on the drug being taken. Doxycycline can cause heartburn and indigestion; mefloquine (Lariam) can cause anxiety attacks, insomnia and nightmares and (rarely) severe psychiatric disorders; chloroquine can cause nausea and hair loss; and proguanil can cause mouth ulcers. These side effects are not universal and can be minimised by taking medication correctly, eg with food. Also, some people should not take a particular antimalarial drug, eg people with epilepsy should avoid mefloquine, and doxycycline should not be taken by pregnant women or children younger than 12.
If you decide that you really don’t want to take antimalarial drugs, you must understand the risks and be obsessive about avoiding mosquito bites. Use nets and insect repellent, and report any fever or flu-like symptoms to a doctor as soon as possible. Some people advocate homeopathic preparations against malaria, such as Demal200, but as yet there is no conclusive evidence that this is effective, and many homeopaths do not recommend their use. Malaria in pregnancy frequently results in miscarriage or premature labour and the risks to both mother and foetus during pregnancy are considerable. Travel in Tanzania when pregnant should be carefully considered.
If you will be away from major towns, carrying emergency stand-by treatment is highly recommended, and essential for travel in remote areas. Be sure to seek your doctor’s advice before setting off as to recommended medicines and dosages. However, this should be viewed as emergency treatment only and not as routine self-medication, and should only be used if you will be far from medical facilities and have been advised about the symptoms of malaria and how to use the medication. If you do resort to emergency self-treatment, seek medical advice as soon as possible to confirm whether the treatment has been successful. In particular, you want to avoid contracting cerebral malaria, which can be fatal within 24 hours. Self-diagnostic kits, which can identify malaria in the blood from a finger prick, are available in the West and are worth buying.
Meningococcal infection is spread through close respiratory contact and is more likely in crowded places, such as dormitories, buses and clubs. While the disease is present in Tanzania, infection is uncommon in travellers. Vaccination is recommended for long stays and is especially important towards the end of the dry season. Symptoms include a fever, severe headache, neck stiffness and a red rash. Immediate medical treatment is necessary.
The ACWY vaccine is recommended for all travellers in sub-Saharan Africa. This vaccine is different from the meningococcal meningitis C vaccine given to children and adolescents in some countries; it is safe to be given both types of vaccine. Self-treatment: none.
This disease is caused by the larvae of a tiny worm, which is spread by the bite of a small fly. The earliest sign of infection is intensely itchy, red, sore eyes. It’s rare for travellers to be severely affected. Treatment undertaken in a specialised clinic is curative. Self-treatment: none.
This disease is generally spread through contaminated food and water. It is one of the vaccines given in childhood and should be boosted every 10 years, either orally (a drop on the tongue) or else as an injection. Polio can be carried asymptomatically (ie showing no symptoms) and could cause a transient fever. In rare cases it causes weakness or paralysis of one or more muscles, which might be permanent. Self-treatment: none.
Rabies is spread via the bite or lick of an infected animal on broken skin. It is always fatal once the clinical symptoms start (which might be up to several months after an infected bite), so post-bite vaccination should be given as soon as possible. Post-bite vaccination (whether or not you’ve been vaccinated before the bite) prevents the virus from spreading to the central nervous system. Consider vaccination if you’ll be travelling away from major centres (ie anywhere where a reliable source of post-bite vaccine is not available within 24 hours). Three preventive injections are needed over a month. If you have not been vaccinated you’ll need a course of five injections starting 24 hours, or as soon as possible, after the injury. If you have been vaccinated, you’ll need fewer post-bite injections, and have more time to seek medical help. Self-treatment: none.
This disease is a risk throughout Tanzania. It’s spread by flukes (parasitic flatworm) that are carried by a species of freshwater snail, which then sheds them into slow-moving or still water. The parasites penetrate human skin during swimming and then migrate to the bladder or bowel. They are excreted via stool or urine and could contaminate fresh water, where the cycle starts again. Swimming in suspect freshwater lakes (including Lake Victoria) or slow-running rivers should be avoided. Symptoms range from none to transient fever and rash, and advanced cases might have blood in the stool or in the urine. A blood test can detect antibodies if you might have been exposed, and treatment is readily available. If not treated, the infection can cause kidney failure or permanent bowel damage. It’s not possible for you to infect others. Self-treatment: none.
This disease is spread via the bite of the tsetse fly. It causes headache, fever and eventually coma. If you have these symptoms and have negative malaria tests, have yourself evaluated by a reputable clinic in Dar es Salaam, where you should also be able to obtain treatment for trypanosomiasis. There is an effective treatment. Self-treatment: none.
TB is spread through close respiratory contact and occasionally through infected milk or milk products. BCG vaccination is recommended if you’ll be mixing closely with the local population, especially on long-term stays, although it gives only moderate protection against TB. TB can be asymptomatic, only being picked up on a routine chest X-ray. Alternatively, it can cause a cough, weight loss or fever, sometimes months or even years after exposure. Self-treatment: none.
This is spread through food or water contaminated by infected human faeces. The first symptom is usually a fever or a pink rash on the abdomen. Septicaemia (blood poisoning) can sometimes occur. A typhoid vaccine (typhim Vi, typherix) will give protection for three years. In some countries, the oral vaccine Vivotif is also available. Antibiotics are usually given as treatment, and death is rare unless septicaemia occurs. Self-treatment: none.
Tanzania (including Zanzibar) requires you to carry a certificate of yellow-fever vaccination only if you are arriving from an infected area (which includes Kenya). However, it is a requirement in some neighbouring countries (eg Rwanda, Burundi). Yellow fever is spread by infected mosquitoes. Symptoms range from a flu-like illness to severe hepatitis (liver inflammation), jaundice and death. The yellow-fever vaccination must be given at a designated clinic and is valid for 10 years. It is a live vaccine and must not be given to immunocompromised or pregnant travellers. Self-treatment: none.
It’s not inevitable that you’ll get diarrhoea while travelling in Tanzania, but it’s likely. Diarrhoea is the most common travel-related illness, and sometimes can be triggered simply by dietary changes. To help prevent diarrhoea, avoid tap water, only eat fresh fruits or vegetables if cooked or peeled and be wary of dairy products that might contain unpasteurised milk. Although freshly cooked food can be a safe option, plates or serving utensils might be dirty, so be selective when eating from street vendors (make sure that cooked food is piping hot all the way through). If you develop diarrhoea, be sure to drink plenty of fluids, preferably an oral rehydration solution. A few loose stools don’t require treatment, but if you start having more than four or five stools a day you should start taking an antibiotic (usually a quinoline drug, such as ciprofloxacin or norfloxacin) and an antidiarrhoeal agent (such as loperamide) if you are not within easy reach of a toilet. If diarrhoea is bloody, persists for more than 72 hours or is accompanied by fever, shaking chills or severe abdominal pain, seek medical attention.
Unless your intestines are well accustomed to Tanzania, don’t drink tap water that hasn’t been boiled, filtered or chemically disinfected (eg with iodine tablets) and be wary of ice and fruit juices diluted with unpurified water. Avoid drinking from streams, rivers and lakes unless you’ve purified the water first. The same goes for drinking from pumps and wells; some bring pure water to the surface, but the presence of animals can contaminate supplies. Bottled water is widely available, except in very remote areas, where you should carry a filter or purification tablets.
Contracted by eating contaminated food and water, amoebic dysentery causes blood and mucus in the faeces. It can be relatively mild and tends to come on gradually, but seek medical advice if you think you have the illness as it won’t clear up without treatment with specific antibiotics.
This is caused by ingesting contaminated food or water. The illness usually appears a week or more after you have been exposed to the offending parasite. Giardiasis might cause only a short-lived bout of typical travellers’ diarrhoea, but it can also cause persistent diarrhoea. Seek medical advice if you suspect you have giardiasis. If you are in a remote area you could start a course of antibiotics, with medical follow-up when feasible.
Good medical care is available in Dar es Salaam, and reasonable-to-good care is available in Arusha and in some mission stations. Otherwise, you’ll need to go to Nairobi (Kenya), which is the main destination for medical evacuations from Tanzania, or return home. If you have a choice, try to find a private or mission-run clinic, as these are generally better equipped than government ones. If you fall ill in an unfamiliar area, ask staff at your hotel or resident expatriates where the best nearby medical facilities are; in an emergency contact your embassy. Larger towns have at least one clinic where you can get an inexpensive malaria test and, if necessary, treatment.
Pharmacies in major towns are generally well stocked for commonly used items, and rarely require prescriptions; always check expiry dates. Antimalarials are relatively easy to obtain in larger towns. However, it's recommended to bring antimalarials, as well as drugs for chronic diseases, from home. Some drugs for sale in Tanzania might be ineffective: they might be counterfeit (especially antimalarial tablets and antibiotics) or might not have been stored under the right conditions. The availability and efficacy of condoms also cannot be relied upon; they might not be of the same quality as in Europe or Australia and might have been incorrectly stored.
There is a high risk of contracting HIV from infected blood transfusions. The BloodCare Foundation (www.bloodcare.org.uk) is a good source of safe blood, which can be transported to any part of the world within 24 hours.
According to some estimates, at least 80% of Tanzanians rely in part or in whole on traditional medicine, and close to two-thirds of the population have traditional healers as their first point of contact in case of illness. The mganga (traditional healer) holds a revered position in many communities, and traditional-medicinal products are widely available in local markets. In part, the heavy reliance on traditional medicine is because of comparatively higher costs of conventional Western-style medicine, and because of prevailing cultural attitudes and beliefs, but also because it sometimes works. Often, though, it’s because there is no other choice. In northeastern Tanzania, for example, it is estimated that while there is only one medical doctor to over 30,000 people, there is a traditional healer for approximately every 150 people. Countrywide, hospitals and health clinics are concentrated in urban areas, and most are limited in their effectiveness because of insufficient resources and chronic shortages of equipment and medicines.
While some traditional remedies seem to work on malaria, sickle-cell anaemia, high blood pressure and other ailments, most traditional healers learn their art by apprenticeship, so education (and consequently application of knowledge) is often inconsistent and unregulated. At the centre of efforts to correct these problems is the Institute of Traditional Medicine. Among other things, the institute is studying the efficacy of various traditional cures, and promoting those that are found to be successful. There are also local efforts to create healers’ associations, and to train traditional practitioners in sanitation and other topics.
If you are trekking at high altitudes, such as on Mt Kilimanjaro or Mt Meru, you’ll need to have appropriate clothing and be prepared for cold, wet conditions. Even in lower areas, such as the Usambara Mountains, the rim of Ngorongoro Crater or the Ulugurus, conditions can be wet and quite chilly.
Symptoms of hypothermia are exhaustion, numb skin (particularly of the toes and fingers), shivering, slurred speech, irrational or violent behaviour, lethargy, stumbling, dizzy spells, muscle cramps and violent bursts of energy. Irrationality may take the form of sufferers claiming they are warm and trying to take off their clothes.
To treat mild hypothermia, first get the person out of the wind and/or rain, remove their clothing if it’s wet and replace it with dry, warm clothing. Give them hot liquids – not alcohol – and high-kilojoule, easily digestible food. Do not rub victims: allow them to slowly warm themselves instead. This should be enough to treat the early stages of hypothermia. The early recognition and treatment of mild hypothermia is the only way to prevent severe hypothermia, which is a critical condition.
Bites from mosquitoes and other insects can cause irritation and infected bites. To avoid these, take the same precautions as you would for avoiding malaria. Bee and wasp stings cause real problems only to those who have a severe allergy to the stings (anaphylaxis), in which case, carry an adrenaline (epinephrine) injection.
Scorpions are found in arid areas. They can cause a painful bite that is sometimes life-threatening. If bitten by a scorpion, seek immediate medical assistance.
Bed bugs are often found in hostels and cheap hotels. They lead to very itchy, lumpy bites. Spraying the mattress with crawling insect killer after changing the bedding will get rid of them.
Scabies is also frequently found in cheap accommodation. These tiny mites live in the skin, particularly between the fingers. They cause an intensely itchy rash. The itch is easily treated with Malathion and permethrin lotion from a pharmacy; other members of the household also need to be treated to avoid spreading scabies, even if they do not show any symptoms.
This condition occurs after heavy sweating and excessive fluid loss with inadequate replacement of fluids and salt, and is primarily a risk in hot climates when taking unaccustomed exercise before full acclimatisation. Symptoms include headache, dizziness and tiredness. Dehydration is already happening by the time you feel thirsty; aim to drink sufficient water to produce pale, diluted urine. Self-treatment: fluid replacement with water and/or fruit juice, and cooling the body with cold water and fans. The treatment of the salt-loss component consists of consuming salty fluids (as in soup) and adding a little more table salt to foods than usual.
Reduced oxygen levels at altitudes above 2500m affects most people. The effect may be mild or severe and occurs because less oxygen reaches the muscles and the brain at high altitudes, requiring the heart and lungs to compensate by working harder. Symptoms of Acute Mountain Sickness (AMS) usually develop during the first 24 hours at altitude but may be delayed for up to three weeks. Mild symptoms include headache, lethargy, dizziness, sleeping difficulties and loss of appetite. AMS may become more severe without warning and can be fatal. It is a significant risk for anyone, no matter what their fitness level, who tries to ascend Mt Kilimanjaro or Mt Meru too rapidly. Severe symptoms include breathlessness; a dry, irritative cough (which may progress to the production of pink, frothy sputum); severe headache; lack of coordination and balance; confusion; irrational behaviour; vomiting; drowsiness; and unconsciousness. There is no hard-and-fast rule as to what is too high: AMS has been fatal at 3000m, although 3500m to 4500m is the usual range.
Treat mild symptoms of AMS by resting at the same altitude until recovery, which usually takes a day or two. Paracetamol or aspirin can be taken for headaches. If symptoms persist or become worse, however, immediate descent is necessary; even descending just 500m can help. Drug treatments should never be used to avoid descent or to enable further ascent.
The drugs acetazolamide and dexamethasone are recommended by some doctors for the prevention of AMS; however, their use is controversial. They can reduce the symptoms, but they may also mask warning signs and cause severe dehydration; severe and fatal AMS has occurred in people taking these drugs. In general we do not recommend them for travellers.
To prevent AMS, try the following:
Heat exhaustion is a precursor to the much more serious condition of heatstroke. In this case there is damage to the sweating mechanism, with an excessive rise in body temperature; irrational and hyperactive behaviour; and, eventually, loss of consciousness and death. Rapid cooling by spraying the body with water and fanning is ideal. Emergency fluid and electrolyte replacement is usually also required by intravenous drip.
Avoid getting bitten! Don’t walk barefoot or stick your hand into holes or cracks. However, 50% of those bitten by venomous snakes are not actually injected with poison (envenomed). If bitten by a snake, do not panic. Immobilise the bitten limb with a splint (such as a stick) and apply a bandage over the site with firm pressure, similar to bandaging a sprain. Do not apply a tourniquet, or cut or suck the bite. Get medical help as soon as possible so an antivenin can be given if needed. Try to note the snake’s appearance to help in treatment.